Middle-aged and older adults who suffer from high levels of stress, hostility, or depression are at greater risk for stroke or transient ischemic attack (a stroke caused by a temporary blockage of blood flow to the brain), according to new research published in the journal Stroke.

The data included more than 6,700 adults (ages 45-84; 53 percent women) who reported their chronic stress levels, depressive symptoms, anger, and hostility over a two-year period. Participants were 38.5 percent white, 27.8 percent African-American, 11.8 percent Chinese, and 21.9 percent Hispanic. All were free of cardiovascular disease at the start of the study.

During follow-up 8.5 to 11 years later, 147 strokes and 48 TIAs occurred. Compared to people with the lowest psychological scores, those with highest scores were:

86 percent more likely to have a stroke or TIA for high depressive symptoms;

59 percent more likely to have a stroke or TIA for the highest chronic stress scores;

more than twice as likely to have a stroke or TIA for the highest hostility scores;

no significant increased risk was linked to anger.

“There’s such a focus on traditional risk factors — cholesterol levels, blood pressure, smoking, and so forth — and those are all very important, but studies like this one show that psychological characteristics are equally important,” said lead author Susan Everson-Rose, Ph.D., M.P.H., associate professor of medicine at the University of Minnesota in Minneapolis.

“Given our aging population, it’s important to consider these other factors that might play a role in disease risk. Stroke is a disease of the elderly predominantly, and so learning more about things that can influence risk for stroke as people age is important.”

Researchers measured chronic stress in five domains: personal health problems, health problems of others close to the participant, job or ability to work, relationships, and finances.

Depressive symptoms were measured with a 20-question scale and anger was measured with a 10-item scale that captured the extent and frequency of experiencing that emotion. Hostility was measured by assessing a person’s cynical expectations of other people’s motives.

“One thing we didn’t assess is coping strategies,” Everson-Rose said. “If someone is experiencing depressive symptoms or feeling a lot of stress or hostility, we don’t know how they manage those, so it’s possible that positive coping strategies could ameliorate some of these associations or effects.”